| NPI | 1912926437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME74008) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL me74008) |
| 207Q00000X Family Medicine (Licence: MT 11461) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-02-20 |